Operating Room Gonioscopy in Angle-Closure Glaucoma Surgery

It is now generally accepted that iridectomy is the most logical, the most effective, and the safest operation for the control of angle-closure glaucoma. Unfortunately, it is ineffective if the anterior chamber angles are occluded by permanent peripheral anterior synechias. The purpose of this paper is to present a technique for determining the presence or absence of synechias at the time of surgery. When tension can be restored to normal by medical means within 12 hours in angleclosure glaucoma, conventional presurgical diagnostic methods can be employed. If gonioscopy shows that the angle has opened, one can be confident that iridectomy will be curative. If the angle still seems to be blocked, it is probable that the synechias are permanent and that the low tension is on the basis of suppression of aqueous production. This assumption can be proved or disproved by tonography. If the coefficient of aqueous outflow is high,